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L. Bearne1,2, B. Volkmer1, M. Galea Holmes3, A. Amirova1, S. Quirke- McFarlane4, J. Peacock1,5, J. Weinman4, C. Sackley1,6, G. Fisher1, B. Modarai7, J. Bieles1, M. Sekhon1,2
1King's College London, Population Health Sciences, London, United Kingdom, 2St George's, University of London, Population Health Research Institute, London, United Kingdom, 3University College London, Department of Applied Health Research, London, United Kingdom, 4King’s College London, Institute of Pharmaceutical Sciences, London, United Kingdom, 5Dartmouth College, The Geisel School of Medicine at Dartmouth, New Hampshire, United States, 6Nottingham University, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom, 7King’s College London, Academic Department of Vascular Surgery, London, United Kingdom
Background: Supervised walking exercise is recommended for people with intermittent claudication due to peripheral arterial disease (PAD), but uptake and adherence is low. Structured home‐based exercise programmes, that include the support of a healthcare professional, may be more accessible and acceptable to patients and facilitate long-term walking exercise behaviour change.
The Motivating Structured walking Activity for Intermittent Claudication intervention (MOSAIC) aims to improve walking in people with PAD. MOSAIC includes two in-person sessions (Session 1 and Session 2) and two telephone sessions (Session 3 and Session 4) delivered over 3-months. Sessions include mandatory and optional components that are informed by a motivational interviewing (MI) approach and theory-based behaviour change principles. Fifteen physiotherapists received 2-days training and ongoing supervision to deliver MOSAIC as part of a randomised clinical trial.
The Motivating Structured walking Activity for Intermittent Claudication intervention (MOSAIC) aims to improve walking in people with PAD. MOSAIC includes two in-person sessions (Session 1 and Session 2) and two telephone sessions (Session 3 and Session 4) delivered over 3-months. Sessions include mandatory and optional components that are informed by a motivational interviewing (MI) approach and theory-based behaviour change principles. Fifteen physiotherapists received 2-days training and ongoing supervision to deliver MOSAIC as part of a randomised clinical trial.
Purpose: This study assessed the fidelity of delivery of mandatory elements and behaviour change techniques and motivational interviewing proficiency in MOSAIC sessions
Methods: A random sample (stratified by centre) of audio-recorded MOSAIC sessions were identified. Randomly selected 20-minute segments of audio-recordings were rated for proficiency of MI delivery by two independent raters using the Motivational Interviewing Treatment Integrity Scale (MITI). The MITI comprises four global ratings, and 10 individual behavioural counts.Summary scores for the four global ratings were computed from code frequencies for the 10 behavioural counts to determine MI technical proficiency (application of MI techniques (range 1-5) 3=fair proficiency) and relational proficiency (interpersonal style (range 1-5) 3.5=fair proficiency).
Two independent assessors rated the full audio-recordings of the selected MOSAIC sessions using a bespoke checklist to assess the extent to which MOSAIC mandatory components and Behaviour Change Techniques (BCTs) (Session 1 n=10; Session 2 n=12; Session 3 n=8; Session 4 n=8) were delivered. High treatment fidelity was calculated according to whether ≥80% of mandatory components and BCTs were rated as fully/partially delivered from calibrated total scores for each individual session.
Two independent assessors rated the full audio-recordings of the selected MOSAIC sessions using a bespoke checklist to assess the extent to which MOSAIC mandatory components and Behaviour Change Techniques (BCTs) (Session 1 n=10; Session 2 n=12; Session 3 n=8; Session 4 n=8) were delivered. High treatment fidelity was calculated according to whether ≥80% of mandatory components and BCTs were rated as fully/partially delivered from calibrated total scores for each individual session.
Results: Sixty-two (21%) audio-recorded MOSAIC sessions were rated. The physiotherapists delivered MOSAIC with fair MI technical proficiency in all sessions (3.2-3.9 out of 5). Fair relational proficiency in the in-person sessions (both 3.5 out of 5) but not the telephone sessions (Session 1: 3.1 out of 5; Session 2: 3.2 out of 5).
Overall, fidelity of delivery was 79% (47/62 sessions). High fidelity was achieved in both in-person sessions (Session 1: 100%; Session 2: 88%) but not in the telephone sessions (Session 3: 67%; Session 4: 54%).
Overall, fidelity of delivery was 79% (47/62 sessions). High fidelity was achieved in both in-person sessions (Session 1: 100%; Session 2: 88%) but not in the telephone sessions (Session 3: 67%; Session 4: 54%).
Conclusions:Physiotherapists delivered MOSAIC with acceptable treatment fidelity and fair technical and relational MI proficiency in the in-person sessions but lower treatment fidelity and relational MI proficiency was achieved in the telephone sessions.
Implications: The MOSAIC intervention can be delivered with fidelity by physiotherapists following brief training although future training should optimise the delivery of the remote MOSAIC sessions and MI proficiency. Integrating psychological approaches such as MI and BCTs into clinical practice extends physiotherapists skills to support long-term behaviour change.
Funding acknowledgements: This work was supported by The Dunhill Medical Trust: grant number R477/0516
Keywords:
Peripheral Arterial Disease
Walking exercise
Treatment fidelity
Peripheral Arterial Disease
Walking exercise
Treatment fidelity
Topics:
Disability & rehabilitation
Older people
Community based rehabilitation
Disability & rehabilitation
Older people
Community based rehabilitation
Did this work require ethics approval? Yes
Institution: National Research Ethics Committee London–Bloomsbury, United Kingdom
Committee: National Research Ethics Committee London–Bloomsbury, United Kingdom
Ethics number: 17/LO/0568
All authors, affiliations and abstracts have been published as submitted.
